CPT code 11011 is for the debridement of skin and muscle at a fracture site, ensuring proper healing and preventing infection.
CPT code 11011 is used to describe the medical procedure of debriding, or cleaning, the skin and muscle at a fracture site. This involves the removal of dead, damaged, or infected tissue to help promote healing and prevent infection. This code is specifically used when the debridement is performed at the location of a bone fracture.
When using CPT code 11011 for debridement of skin and muscle at a fracture site, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the debridement procedure required significantly more effort or time than usual due to complications or other factors.
2. Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): Apply this modifier if an unrelated evaluation and management service is performed by the same physician during the postoperative period of the debridement.
3. Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service): Use this modifier if a significant, separately identifiable evaluation and management service is provided by the same physician on the same day as the debridement.
4. Modifier 50 (Bilateral Procedure): Apply this modifier if the debridement procedure is performed bilaterally.
5. Modifier 51 (Multiple Procedures): Use this modifier if multiple procedures, including the debridement, are performed during the same surgical session.
6. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): Apply this modifier if the debridement is a staged or related procedure during the postoperative period of an initial surgery.
7. Modifier 59 (Distinct Procedural Service): Use this modifier to indicate that the debridement is a distinct procedural service from other services performed on the same day.
8. Modifier 76 (Repeat Procedure or Service by Same Physician): Apply this modifier if the debridement procedure needs to be repeated by the same physician.
9. Modifier 77 (Repeat Procedure by Another Physician): Use this modifier if the debridement procedure is repeated by a different physician.
10. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Apply this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Use this modifier if an unrelated procedure or service is performed by the same physician during the postoperative period.
12. Modifier 80 (Assistant Surgeon): Apply this modifier if an assistant surgeon is required for the debridement procedure.
13. Modifier 81 (Minimum Assistant Surgeon): Use this modifier if a minimum assistant surgeon is required for the procedure.
14. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Apply this modifier if an assistant surgeon is required because a qualified resident surgeon is not available.
15. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each modifier serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 11011 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS).
The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. Additionally, the reimbursement for CPT code 11011 may vary depending on the local policies set by the Medicare Administrative Contractor (MAC) for your region.
It is essential to consult the MPFS and your regional MAC guidelines to determine the exact reimbursement details and any additional requirements that may apply.
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